2012 AHA Policy Research

AHA research reports examine key issues to inform the policy making process. These include the TrendWatch series, a periodic AHA publication that reports on the latest trends affecting hospitals and the health care system (now conducted in collaboration with Avalere Health* www.avalerehealth.net), as well as other AHA sponsored studies.

Are Medicare Patients Getting Sicker? TrendWatch, December 2012Today, Medicare covers more than 48 million people, and that number is growing rapidly—baby boomers are reaching the eligibility age of 65 at the rate of 10,000 a day. Medicare patients exhibit a growing prevalence of chronic conditions and risk factors for these conditions, such as obesity. This in turn is leading to a rise in Medicare beneficiaries’ use of health care services and has implications for resource use and payment policy.

Health Care Spending Growth Slows Dramatically, December 2012Policymakers and the public continue to be concerned by the growth in national health expenditures. Medicare, Medicaid and the Children's Health Insurance Program (CHIP) comprise 21 percent of the federal budget, and overall spending on health care accounts for nearly 18 percent of the Gross Domestic Product (GDP). With an aging population, rising rates of chronic disease and continued advances in medicine, many fear that spending will only continue to grow. However, health care spending growth has slowed to near-record lows in recent years.

Prepared to Care: The 24/7 Standby Role of America's Hospitals, November 2012America's hospitals are vital to meeting the health care needs of the communities they serve by providing a wide range of acute-care and diagnostic services, supporting public health needs, and offering myriad other community services to promote the health and well-being of the community. While many of these services also are provided by other health care providers, three things make the role of the hospital unique.

Hospitals Demonstrate Commitment to Quality Improvement, Trendwatch, October 2012Hospitals are on a never-ending journey of quality improvement — employing new technologies and techniques and research on what works, as well as continuously training new workers and meeting the needs of sicker patients. While hospitals are at different points on their quality path, all hospitals are committed to quality improvement. This commitment has helped hospitals make great strides in increasing adherence to treatment protocols and improving patient outcomes.

Medicare Payment Bundling: Insights from Claims Data and Policy Implications,October 2012A Report by Dobson | DaVanzoThere has been a growing interest over the past several years in the concept of payment bundling, whereby services for physicians, hospitals, post-acute care providers and others would be "bundled" together into a single payment covering an episode of care over a specified period of time. In order to implement a bundled payment system in the Medicare program, a series of operational issues needs to be considered by policymakers and providers regarding how the episode of care would be defined, how the bundled payment would be priced and how care that is delivered under the bundled payment would be managed.

The Negative Employment Impacts of the Medicare Cuts in the Budget Control Act of 2011, September 2012A Report by Tripp UmbachIn July 2012, Tripp Umbach conducted an analysis to measure the economic impact of the Budget Control Act of 2011 (BCA), which mandated a 2% sequester of Medicare spending over the next nine years from 2013 until 2021 in order to help reduce the deficit. This report presents the employment impacts on health care providers and other related industries affected by the cuts to Medicare funding at national, state, and local levels.

Bringing Behavioral Health into the Care Continuum: Opportunities to Improve Quality, Costs and Outcomes, TrendWatch, January 2012One in four Americans experiences a mental illness or substance abuse disorder each year, and the majority also has a comorbid physical health condition. In 2009, more than 2 million discharges from community hospitals were for a primary diagnosis of mental illness or substance abuse disorder. The range of effective treatment options for behavioral health disorders - which encompass both mental illness and substance abuse disorders - is expanding. Research indicates that better integration of behavioral health care services into the broader health care continuum can have a positive impact on quality, costs and outcomes. Health reform creates new impetus and opportunity for better managing the care delivered to individuals with behavioral health conditions. Expansion of health insurance generally, along with improved coverage of behavioral health treatment under parity laws, will broaden access to needed services. At the same time, increased provider accountability will spur efforts to coordinate care across currently fragmented settings to improve the efficiency and effectiveness of care delivered to individuals with behavioral health conditions. Many providers already are working with private payers to meet these same goals. Initiatives span value-based purchasing, accountable care organizations, patient-centered medical homes, and efforts to reduce readmissions. These initiatives will have important implications for the delivery of behavioral health care. And as the demand for behavioral health services is likely to continue to outstrip capacity, improving care integration can help to better manage this need.

As providers take on shared accountability for health care across the continuum, they should not overlook patients' behavioral health care needs. Health care organizations and providers that can effectively integrate care across treatment settings as well as between the behavioral and physical health care systems should realize gains in quality and outcomes, and reduced treatment costs.